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The last 10 years has brought transformative developments in the effective treatment of myasthenia gravis (MG). Beginning with the randomized trial of thymectomy in myasthenia gravis that demonstrated efficacy of thymectomy in nonthymomatous MG, several new treatment approaches have completed successful clinical trials and regulatory launch. These modalities, including B cell depletion, complement inhibition, and blockade of the neonatal Fc receptor, are now in use, offering prospects of sustained remission and neuromuscular protection in what is a long-term disease.
This review updates the 2016 clinico-immunological review with recent advances, examines their role in treatment algorithms, and draws attention to key issues related to biomarkers for prognostication and the growing cohort of older patients, including those with long-term disease and late-onset MG (LOMG).
The review concludes by outlining four priorities for the next 5–10 years: advancements in laboratory medicine to facilitate rapid diagnosis, effective strategies for neuromuscular protection, further research into the pathophysiology and treatment response in older individuals, and the potentially transformative role of therapies aimed at achieving durable responses, such as chimeric antigen receptor (CAR) T cells.
A postscript summarizes emerging themes in serological and online biomarkers, which may gain greater significance in the future.